(For additional information see "Sucrose: Pediatric drug information")
Analgesia (mild)/Comfort: Oral:
Manufacturer's labeling: Infants: 0.2 to 0.5 mL of 24% sucrose solution placed on the tongue or buccal surface or dip pacifier in sucrose solution and allow infant to suck
Immunization: Limited data available; optimal dose not established: Infants: Usual dose: 2 mL of 24% solution administered 1 to 2 minutes prior to vaccine administration; effective range: 1 to 2 mL of 12% to 75% solution (Kassab 2012)
Minor ED painful procedures (eg, heel sticks, venipuncture, IV line insertion, arterial puncture, insertion of a Foley catheter, and lumbar puncture): Limited data available: Infants ≤6 months: 2 mL of 25% sucrose no more than 2 minutes before the start of the painful procedure; may be administered as 1 mL in each cheek or allow infant to suck solution from pacifier (AAP [Fein 2012])
There are no dosage adjustments in the manufacturer's labeling.
There are no dosage adjustments in the manufacturer's labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, oral:
Sweet-Ease® Preserved: 24% (15 mL)
TootSweet™: 24% (0.5 mL, 1 mL, 2 mL, 12 mL)
Solution, oral [preservative free]:
Sweet-Ease Natural®: 24% (15 mL)
No
For oral use only. May be administered directly onto baby's tongue or buccal surface or via a pacifier dipped into solution. Dispose of product after use.
Volume of drops differs between dropper (cup) and vial:
Sweet-ease vial: 5 to 8 drops equivalent to 0.2 to 0.5 mL
Sweet-ease cup: Dropper: 1 to 2 drops equivalent to 0.2 to 0.5 mL. Pacifier dip: 1 dip equivalent to 0.1 mL.
Provide short-term analgesia in infants during immunization administration
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined.
Cardiovascular: Bradycardia (self-limiting)
Hematologic & oncologic: Oxygen desaturation (premature neonates; spontaneous resolution)
Respiratory: Apnea (brief apnea in premature neonates; spontaneous resolution)
Disease-related concerns:
• Gastrointestinal disorders: Patients should have a functioning gastrointestinal tract; avoid use in patients with gastrointestinal tract abnormalities (eg, esophageal atresia or tracheal esophageal fistula); while necrotizing enterocolitis (NEC) has not been reported with sucrose administration, risk:benefit assessment should be considered in patients at high risk for NEC.
Special populations:
• Neonates: Efficacy in unstable or extremely low birth weight, premature neonates has not been established (LeFrak 2006).
Other warnings/precautions:
• Appropriate use: Avoid use in patients at risk for aspiration; sucrose should not be used for patients requiring ongoing analgesia.
Use with caution in patients who are intubated to avoid gagging and choking; avoid use in paralyzed patients (LeFrak 2006).
Concerns have been raised regarding repeated use of sucrose in patients <31 weeks postconceptual age and neurodevelopmental and physical outcomes. In a randomized, double-blind, placebo-controlled trial, 103 neonates were randomized to sucrose (n=53) or sterile water at the beginning of minor procedures, repeat doses were given every 2 minutes for 3 doses or if longer than 15 minutes, 3 more doses were allowed. Patients receiving a higher number of sucrose doses had lower scores on motor development and vigor, and alertness and orientation components of the Neurobehavioral Assessment of the Preterm Infant (NAPI) at 36 weeks postconceptual age, lower motor development and vigor at 40 weeks postconceptual age, and higher Neuro-Biological Risk Score (NBRS) at 2 weeks postnatal age (Johnston 2002). The authors conducted a secondary analysis of the raw data and suggested neonates receiving >10 doses of sucrose over a 24-hour period are at a higher risk of poorer neurodevelopmental outcomes (Johnston 2007).
Exact mechanism is not known; it has been proposed that sucrose induces endogenous opioid release.
Onset: Maximum effect: 2 minutes (Blass 1991)
Duration: 3 to 5 minutes (Blass 1991)
